Emergency Medicine and Hospital Negligence

Category: Health

In this year’s compensation report by Medscape EM Physician CompensationSurvey, reported in April, accounting for nearly19,200 respondents in over 26 specialties disclosed their income, working hours, career satisfaction, their major rewards and whether they’d choose medicine again and more.

Overall Earning by EM Physicians:

Each physician who participated in the survey were asked to provide their annual compensation for providing patient care. An annual compensation for employed physicians includes salary, bonus, and profit-sharing contributions. And for partners, it involves earnings after deducting taxes as well as business expenses before income tax. This year EM physicians had a compensation of $339,000, ranking them above the middle. Orthopedists were the highest payees at $489,000, whereas pediatricians were at the lowest at $202,000.

Some Specialties Observed Decline:

Cardiologists and Oncologists compensation remained same as 2016 survey. Only Pediatricians were reported to show a decrease this year by 1%. All other specialties showed an increase, also EM physicians (5%),with plastic surgeons’ (24%) and allergists’ (16%)are the largest gainers.

Who Earns Big? US Trained Physician or Foreign Trained Physician?

On average, a compensation difference of 3% has been observed in this year’s report, as US-trained EM physicians earn$340,000more than that of their foreign-trained associates i.e. $330,000. The average compensation earned by the US-trained physicians surveyed is $301,000. Also, the second highest earners are the Canada-trained physicians with $328,000.

Geographic Income Disparities Persist:

This year, EM physicians in the South Central ($395,000), North Central ($381,000),and Southeast ($354,000) regions were the highest average compensation receivers, whereas the lowest compensation receivers was found in the West ($311,000), Northwest ($312,000), and Mid-Atlantic($313,000) regions.

Welfare received by an EM Physician:

This year high percentages of EM physicians responded positively of receiving welfare:

Liability coverage (75%)

Employer-subsidized health insurance(62%)

Employer-subsidized dental insurance (54%)

Employee-matched retirement plans (46%)

Although 14% of EM physicians reported receiving no benefits.

Compensation Satisfaction – Are EM Physicians Fairly Compensated?

Almost 68% of EM physicians reported negatively on being fairly compensated. Of the list, at the bottom most, only 41% of nephrologists feel they are fairly compensated, on contrary 44% of endocrinologists reported dissatisfaction on this subject.

Do EM Physicians think to join MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), commonly called the permanent “Doc Fix,” came into effect on January 1, 2017. In this survey when asked if they – the EM physicians think to join MACRA, to which 43% answered positively.

Hours per Week EM Physicians Spent Seeing Patients?

Most of the EM physicians i.e. 80% of the surveyed, spend 45 hours/week or less with patients.

Would EM Physicians choose medicine again if they had to?

Almost 77% of the EM physicians responded positively when asked if they would do over medicine again if they had to.

Doctor’s, in everyday practice, struggle with key ethical decisions related to everything from pain and death to money and romance. Medscape’s Ethics Survey, 2017, saw more than 7500 physicians responding and sharing their views on the challenges they face ethically. Given below is the synopsis of the responses by the family physicians, to the various questions asked during the survey.

Should a mistake that would harm a patient be ever covered up or avoid being revealed by a physician? Is it an acceptable practice?

About a quarter i.e., 24% of family physician’s responded saying it is or might be acceptable to hide a harmful mistake; a response which in 2014 stood at just 9% answering the same. However, most of the family physicians considered being “honest” and “forthright” in revealing their mistake to all the parties. A large number did also say it would depend on the situation and the consequences.

Should the annual flu shots be made mandatory for the doctors?

Family physicians are not quite fervid to the notion of mandatory flu shots for physicians; in similarity to the profession altogether (63% v/s 67%). While a lot of them got infuriated with this “required flu shot” notion; most of them also thought it to be a good idea – if they expect their patients to undergo immunization, they must lead and set an example for them first.

Should Physician-assisted suicide/dying be made for critically ill patients?

There are extremely mixed opinions from the family physicians concerning physician-assisted suicide and they are also less in favor of this practice than doctors in general (47% v/s 57%). One of the physicians wrote that “Physicians should not be put in the position of hastening death. This flies in the face of the Hippocratic Oath. Individuals can commit suicide without the help of a physician. To use the physician for the provision of a medical benediction diminishes our profession.” To which another physician countered by adding, “We are far more humane to the pets who share our homes than we are with ourselves.”

Would you ever deny information to a competent patient on family’s request?

When asked in 2014, most of the physicians had responded saying that depending on the situation they might deny the information to the patients; however, that is not the scenario anymore. The percentage of family physicians who refused to withhold the information from the patient has almost doubled in 2016 i.e., 78%, compared to 39% in 2014. One of the physicians wrote that “Family members are not my patients. My obligation is only to the patient.” Another physician wrote saying “Absolutely freaking NOT. I was fired once for doing this exact thing.”

Have you ever failed to report or further investigate a patient whom you had suspected to be a victim of domestic abuse?

18% of family physicians out of the total surveyed, responded saying that they have suspected a patient to be a victim of domestic violence, but failed to report it or further investigate, compared to 12% general physicians who said the same. One of the physicians protested saying, “Adult women who will not leave their abuser, are at increased risk for death, if we involve law enforcement” to which another supported, claiming that a patient admitted to abuse, but asked the physician not to report it because the patient’s experience with the previous investigation was negative.

Is it ever appropriate to get involved with a patient in a romantic or sexual relationship?

While 70% of physicians generally say that doctor-patient romance is forbidden, 65% of family physicians find the relationship appropriate. One of the family physician says that it depends on the kind of physician and the type of relationship they share with the patient, to which many contended, noting that such relationships are never acceptable for a psychiatrist. Some said that it would be okay for a physician practicing in a remote area, on which one of the physicians wrote, “I have worked in rural Maine for 38 years. I expect that 30% of my patients are also my friends. I think it is permissible for health providers to become romantically involved with past patients.”

Would you report a colleague who sometimes seemed under the influence of drugs, alcohol or illness?

The vast majority of family physicians (78%) said that they would report an enfeebled colleague, and the percentage is growing. Many asserted saying they would first warn the friend/colleague of what they are going to do. Several reported that they have reported before and the end result has been favorable for the colleague—”they got help and are back practicing”— stating that reporting on a colleague “is not fun.”

Would you tell a patient of your ineptness in a particular procedure before you perform it?

50% of the family physicians said that they would accept and tell the patient of their ineptness for a procedure, while some added that they would refer the patient to another physician. Others, having revealed their inexperience, stressed that they wouldn’t do the procedure if they are not qualified for it.

Should physicians be randomly tested for drug and alcohol abuse?

Family physicians exhibited mixed responses towards the idea of random testing for drug and alcohol abuse, and their viewpoint hasn’t changed much over the span of two years. Family physicians are almost equally divided over whether testing should be allowed (“absolutely”) or is unacceptable (“A positive ETOH or positive THC test does not distinguish between use and abuse and could lead to great harm.”) Besides 1 out of 5 said that it depends on (“if the problem has been identified or if they are in recovery, only then they should be subjected to the test”).

Jenna looked at all the holiday greeting cards spread over her dinner table and sighed. The advent of Thanksgiving heralded the festivals’ season and soon the house would be abuzz with the noise and clatter of her extended family – her cousins and relatives she was used to seeing only once every year and even then it was one too many.

Contrary to most people who eagerly looked forward to the holiday season, Jenna dreaded this time of the year. It was one thing to host the gamut of the McKinney family for a whole weekend at their winter retreat in Florida because her father, in addition to being a successful businessman who owned premium beach property, was also the eldest of all the brothers. Quite another to endure the relentless clamor of uncles who wanted to know which college she was planning to apply to after graduation and aunts who wanted to know the name of the cutest guy at her school.

It all started 5 years ago. An otherwise chirpy and energetic pre-teen at the time, the twelve year old Jenna had pleaded with her dad to cancel the festival reunion that year owing to the deteriorating health of her mother suffering from cancer. Both her parents had declined the proposal – her father because it was family tradition and her mom because she was convinced it would only serve to lift her spirits.

Sure enough, Jenna found her mom immensely happy in the company of her siblings. She hadn’t seen her mother this jovial since her diagnosis with the terminal disease 3 years ago. That weekend, the lady of the house had thrown caution to the wind, disregarded her strict dietary and medical regimen in favor of mirth and merriment, drank and ate freely and danced and sang well into the wee hours of the morning. After all, how much could a few days of deviation from her routine hurt her? She would be back on her strict diet before long and it would be like she never digressed at all.

Sadly, that was not to be. After 2 days of irregular or skipped medication, Jenna’s mom took to bed on Sunday afternoon. Later that evening, she was rushed to the ER. In the wee hours of the morning the next day, Jenna’s mom passed away.

After that, Jenna had always hated the holidays. The next year and the years after that, when her cousins came over, she would mostly lock herself up in her room citing unfinished assignments. The only time her extended family would see her pretty face would be around supper.

But that was so many, many years ago and Jenna could sense a closure in her heart this year. This is why she insisted with her pleasantly surprised and overjoyed dad that she send out the invitations this year. As she diligently hand wrote and signed each invitation herself, Jenna sighed that she hadn’t done this sooner. When you lose a loved one, nothing comforts you more and helps you find inner peace again than the realization that you have an entire family to fall back on.

Holidays, sadly, are one of the busiest times of the year for ER attendants in hospitals. Here’s what you can do to ensure you and your loved ones stay safe this festive season so that the doctors and the nurses at your local hospitals also get to spend more time with their own families!

Don’t get carried away by the moment

Sure, it’s the holiday season. If you could ever forgive yourself for your indiscretions, now’s the time. However, pay heed to your pre-existent conditions. Make sure you’re allergies are in control. Do not discontinue regular medication if you have diabetes, asthma or other health related issues that require constant monitoring.

Substance abuse

More alcohol is consumed during the festive season than the whole year around. The same, unfortunately, is true of harmful drugs and chemicals that can have catastrophic consequences upon your body even in the short run. If you are young and spending the holidays with your peers you are especially susceptible and vulnerable to substance abuse.

Spend the holidays with your family. If you are spending it with your friends, make sure you do not partake in any activity that you would not permit yourself any other time of the year.

Overindulgence

The festive season is a time to party non-stop. However, make sure that you are getting enough sleep in between all the fun and enjoyment. Also, don’t forget to drink plenty of fluids to keep your-self hydrated. Eat regularly to keep your energy up.

Melancholy

Did you lose a loved one during the festive season? How about a family member you desperately wanted to spend time with but could not be together? Are you prone to stress, anxiety and depression? Holidays can be tough on people who have lost loved ones, living away from family or are generally introverts. Make sure you exercise, eat, drink and sleep regularly. Do all those activities that keep you motivated year round.

Injuries

The holidays are Christmas time for all kinds of injuries, big or small. Do you know how many paper cut victims end up in ER while wrapping or opening presents? Well, thankfully not that many but hospitals are flooded with broken bones, bloody gashes and dislocated shoulders during the festive season.

Have fun during the holidays but do not forget to listen to your spider senses when they start tingling signaling that something has or is about to go wrong.

Physician assistants have never had it so good – a rapid growth in demand and compensation like never before, according to multiple studies in 2015. Even with a nationwide shortage of doctors required to treat millions of newly insured Americans, the demand for physician assistants is growing with compensation averaging $100,000 across the U.S.

Nationally certified by the commission and licensed in the states where they practice, a physician assistant generally has a two-year master’s degree, often from a program that runs about two years and includes three years of healthcare training. They work in doctor’s offices, retail clinics and other locations and their work includes diagnosing illnesses, writing prescriptions and counseling patients on preventive care. Physician assistants and other allied health professionals like nurse practitioners are increasingly an integral part of value-based care models proliferating across the country like Accountable Care Organizations (ACOs) and patient-centered medical homes that contract with insurers, Medicare and Medicaid programs.

According to a report from the American Academy of PAs (AAPA), physician assistants saw a 3.4 percent increase in median provider compensation between 2014 and 2015. The study indicates that the increased demand for physician assistants led to increases in their compensation in 2015. Gathering feedback from about 16,000 respondents, the 2016 AAPA Salary Report revealed rapid growth in the physician assistant workforce, with the profession increasing by more than 33 percent between 2010 and 2015. Since 1980, this workforce has doubled in size every decade. The study found that the median annual salary for physician assistants was $97,000 in 2015 and the median hourly wage came to $55, with about 78 percent of physician assistants receiving a salary, 18 percent paid hourly and 3.7 percent receiving compensation based on productivity. Physician assistants who were more likely to be paid hourly were found to be generally working in urgent care, emergency medicine and convenient care.

According to the researchers, the highest paid physician assistants with a $120,000 median base salary were employed in hospital critical access departments, followed by those in industrial facility and work site settings ($114,003) and hospital intensive care and critical care units ($108,000). The study also stated that provider compensation for some physician assistants included bonuses, with about 49 percent of full-time clinically practicing physician assistants earning a bonus payment in 2015. 50% of those providers reported a bonus of $5,000 or more. Bonuses were given based on a variety of factors, including milestone achievements, employee performance, practice performance, collections productivity, relative value unit productivity, incentives, and holidays.

The study indicated that physician assistant compensation has consistently risen faster than both the national inflation rate and most other professions, with provider compensation for physician assistants increasing approximately 50 percent faster than the rate of inflation between 2000 and 2015. The good news is that despite significant growth in workforce and compensation rates, the demand for physician assistants remains high nationwide. According to The Bureau of Labor Statistics, physician assistant job demand should grow by 30 percent between 2014 and 2024. The Association of American Medical Colleges projected that the industry will fall short by 61,700 to 94,700 physicians in 2025.

According to another healthcare employment study from Health eCareers, physician assistant compensation grew by 4.3 percent and demand for physician assistants and nurse practitioners increased due to physician shortages. With payment reforms promoting more access to preventative services and about 54.8 million Americans touching the age of 65 by 2020, healthcare organizations are seeking more providers to add to their staffing rosters. However, many are finding it difficult to hire and retain providers because of physician shortages. According to the study, in order to offset a lack of physicians, healthcare organizations have opened new physician assistant and nurse practitioner positions.

According to Jennifer L. Dorn, AAPA CEO, “The growth of the PA profession in terms of size and compensation is just the tip of the iceberg. PAs are going beyond just healthcare by taking on new leadership roles in health systems around the country. They are well positioned to drive change as the US healthcare system adapts to a growing and aging population, the shift towards value-based care, and a renewed focus on patient education and prevention. In short, the state of the PA profession has never been stronger.”

The Medscape compensation survey 2016 witnessed the responses of emergency medicine (EM) physicians with regards to their compensation, hours of work on a weekly basis, the time spent with each patient, the ways in which healthcare reforms affected their practice, the rewarding parts about their jobs, etc.

For patient-care compensation for employed physicians, which includes profit-sharing contributions, bonus and salary, there exists a wide range of earnings in various specialties. While orthopedists and cardiologists (including surgical sub-specialists) topped the list with an annual compensation of $443,000 and $410,000 respectively in 2016 (higher than $421,000 and $376,000 as per last year’s compensation report), EM physicians were somewhere in the mid range with compensations of $322,000 on a yearly basis. A 5% increase in income was in the offing for EM physicians – with the highest earnings being reported in the Southwest ($355,000), Southeast ($360,000) and South Central region ($371,000) – while internists experienced a whopping 12% increase. However, practitioners of pulmonology and allergy/immunology experienced a decrease in their income (-5% and -11% respectively).

EM physicians in and healthcare organizations ($327,000) and hospitals($329,000) enjoyed the highest income. Overall, male EM physicians notched $332,000 while their female peers made $279,000 this year ($53,000 less) for full-time positions. The earnings for self-employed EM physicians (female) were $317,000, which was 85% of that of men ($371,000). It’s notable that being self-employed or employed had no role to play in this gender disparity with relation to salary.

60% of EM physicians are satisfied with their earnings and feel fairly compensated. Since
2012, the other physicians who felt duly compensated are dermatologists (66%), pathologists (63%) urologists (42%), and allergists/endocrinologists (both 43%). This year’s report showed that the physicians who earned more believed that they were fairly paid, rather than those who did not match up with them. Over 52% of employed EM physicians (male) and 63% of their female counterparts believed that they are compensated fairly, as compared to 24% and 17% of self-employed EM physicians (male and female respectively).

In the 2016 Medscape report, EM physicians (66%) preferred to choose medicine, but a lesser number (44%) wanted to select their own specialty; these figures were close to the survey results of 2011. Concierge and cash-only practices failed to serve as significant payment models despite a lot of attention being given to these fields.

Over 55% EM physicians have been positively impacted by the Affordable Care Act (ACA) that has paved the way for a large influx of patients. A year after the implementation of this Act, the physicians who believed that the quality of care provided had worsened, 18% reported no increase in patient load while 21% had higher loads. As far as the physicians whose patient load had increased are concerned, 78% felt that the quality was the same or improved; with 82% of physicians who experienced no increase showcasing the same experiences.

In the current Medscape report, 11% EM physicians said that it was inappropriate to drop insurers that paid poorly, while the question did not apply to the remaining ones. As per the report conducted in 2014, more than 58% of physicians had received $100 or less for new-patient office visits by their private insurers.

The report also stated that 67% of EM physicians spent 30-45 hours on a weekly basis seeing patients with only 19% spending more than that. It was also observed that middle-aged physicians worked harder than their older and younger peers. According to the results of the current year’s Medscape Lifestyle Report, spending many hours at work and bureaucratic tasks happened to be the primary causes of burnout in physicians.

It’s unclear how the income of physicians is affected by ACA as many variables have a role to play in the ultimate results. When asked about how their income was affected, 72% of EM physicians who participated in last year’s health insurance exchanges reported no changes while 7% acknowledged that it had increased; and 21% experienced a decrease.

The world is a busy place and is going to keep getting busier. Everybody seems to be running against the clock and physicians are no different. Already swamped, physicians find themselves even busier with the addition of approximately 22.4 million new patients – courtesy the Affordable Care Act. Treating patients, administrative work, departmental and team meetings, conferences, keeping up with the latest developments in healthcare – all these coupled with taking out time for the family and other social commitments, is definitely taking its toll on our healthcare professionals. The result – stress builds up, energy levels drop and very often, mistakes occur. While this is true for nearly all professionals in most fields, the problem with healthcare professionals is that their mistakes can often end up being life threatening.

The reason why most people end up in such stressful situations is because they are not trained to manage their time. Professional courses (other than corporate management training programs) very rarely offer any training on time management. The result – most people end up juggling multiple activities with knowing how to streamline and manage them. Given below are some well tested time management tips that should help you – the healthcare professional to balance your time between the various activities throughout your day.

Prioritize your activities

One of the primary tasks in time management is to prioritize your activities of the day. Make a list of all that you need to do on that day and the time required for each one of them. Keep checking that list to see if you are falling behind schedule. However, remember that the list is not sacrosanct – adjust the activity and time if required. You will find yourself completing more tasks this way.

Evaluate yourself

To effectively manage your time, you need to know what type of a person you are. Conduct a SWOT analysis to understand your strengths and weaknesses, the opportunities and threats that you face. Are you energetic in the mornings or the evening? Do you dash headlong into activities or are you prone to procrastination? Understanding yourself and then allocating time to your activity based on your strengths will help you manage them better.

Use technology to the fullest

Technology is a two way sword – while the internet has made it faster to send and receive messages; it is also the reason for a larger number of not so important messages interrupting you throughout the day. Use technology judiciously. There are software’s available that allow you to streamline your healthcare practice and reduce paperwork. Use mobile applications that allow your patients to review their medical records, book appointments and even get prescriptions without having to visit your facility, save time for both you and the patient.

Optimize your EHR

As in the tip on technology – your EHR can be productive or a time consuming part of technology. This depends totally on how user-friendly your system is, how functional it is for your practice and how well your staff and physicians are trained to work with it. Although it requires time and effort to optimize your system, it pays huge dividends in the long run saving your time and energy by cutting down on paperwork and allowing access to information on your fingertips.

Learn to delegate

You may be a ‘hands on person’, but remember you just have two hands. There is no shame or loss of control in delegating some part of your work to others around you. After all, your administration staff, medical assistants, interns and volunteers are there for this purpose – to take on responsibilities and work and leave you with time to manage your patient’s well being.

You are allowed to say ‘No’

People look up to you and ask for your help frequently – be realistic about your workload. Can you accommodate the request without compromising on your priorities? If yes, then go ahead but if the answer is no, then do yourself and the other person a favor by saying no. Saying yes when you should be saying no will only increase your stress levels, exhaust you mentally and physically and decrease your productivity – none of which will benefit either of you. Attending every conference, speaking at seminars is definitely good for your career – but only if you can continue your career without suffering a burnout from over-exhausting yourself.

Learn to relax

The brain rejuvenates itself when you relax – it could be a power nap, listening to music, taking a walk or just sitting with your eyes closed. A rejuvenated brain works faster and better, allowing you work more efficiently and thus save on the time taken. Schedule small relaxing breaks into your day and follow them as rigorously as you would follow your other activities.

The courts may call upon expert witnesses to give their opinion to establish if the required standard of care was or was not maintained by the physician or healthcare facility, against whom a medical malpractice suit has been filed. The testimony of the medical expert witness is considered as medical practice by the ACEP (American College of Emergency Physicians) as the physician expert witness is qualified not just to render an opinion by virtue of their medical degree, but also has the potential to establish standards of care relevant to the case. The opinion given by a medical expert witness holds great value as well as great responsibility, as it can guide the outcome of the malpractice suit. Given the gravity of such a testimony, it is but natural that there will be certain requisite qualifications required to qualify as an expert witness. Given below is a list of the pre-requisites, in order to be recognized as a medical expert witness.

Should hold a current license within the legal jurisdiction of the US as a doctor of medicine or osteopathic medicine;

Should be actively practicing clinical emergency medicine for a minimum period of three years prior to the date of the medical occurrence which led to the malpractice suit. However, this three year period cannot include the period of training.

In case the physician is currently not engaged in practicing clinical emergency medicine, but was doing so during the three years preceding the medical occurrence date; the physician will still be considered as qualified to be a medical expert witness;

Should be certified in emergency medicine by a recognized certifying entity.

In order to become a medical expert witness, not only does the physician have to qualify as per the above list, but is also expected to follow certain guidelines while providing their views in the case. Failure to adhere to these guidelines can and in most cases does attract severe penalties and disciplinary action.

The expert witness’s opinion must reflect the state of medical knowledge available at the time that the medical occurrence took place.

It is important for the medical expert witness to have current experience in the area of testimony along with current knowledge regarding the same.

The expert witness is required to review the facts of the case and place his testimony in a fair and objective manner without favoring either the plaintiff or the defendant in the case.

Providing testimony that is misleading, false or bereft of a medical foundation will lead to disciplinary action.

While the medical expert witness is required to be familiar with the local laws relating to the practice of emergency medicine, their testimony should adhere strictly to the specific definition of negligence as established by the state.

While solicitation or advertising for being employed as an expert witness is permitted; any misleading, false or deceptive representations in the advertisement or solicitation will bring disciplinary action against the physician.

There should be no compensation arrangement with either the plaintiff or the defendant that is contingent to the outcome of the case.

Transcripts of testimonies or depositions will have to be submitted to peer review, if required.